| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1,151.72 | $1,151.72 | $1,151.72 | |
Molina
| Professional | $60.00 | $60.00 | $85.00 | |
Providence
| Facility | $420.82 | $420.82 | $1,151.72 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,250,000.00 |